Preoperative Metastatic Brain Tumor-Associated Intracerebral Hemorrhage Is Associated With Dismal Prognosis

ObjectIntra-tumoral hemorrhage is considered an imaging characteristic of advanced cancer disease. However, data on the influence of intra-tumoral hemorrhage in patients with brain metastases (BM) remains scarce. We aimed at investigating patients with BM who underwent neurosurgical resection of the metastatic lesion for a potential impact of preoperative hemorrhagic transformation on overall survival (OS).MethodsBetween 2013 and 2018, 357 patients with BM were surgically treated at the authors’ neuro-oncological center. Preoperative magnetic resonance imaging (MRI) examinations were assessed for the occurrence of malignant hemorrhagic transformation.Results122 of 375 patients (34%) with BM revealed preoperative intra-tumoral hemorrhage. Patients with hemorrhagic transformed BM exhibited a median OS of 5 months compared to 12 months for patients without intra-tumoral hemorrhage. Multivariate analysis revealed preoperative hemorrhagic transformation as an independent and significant predictor for worsened OS.ConclusionsThe present study identifies preoperative intra-tumoral hemorrhage as an indicator variable for poor prognosis in patients with BM undergoing neurosurgical treatment.

Systematic review of imaging tests to predict the development of rheumatoid arthritis in people with unclassified arthritis

Objectives. To estimate and compare the diagnostic accuracy of magnetic resonance imaging (MRI) and ultrasound, for the prediction of rheumatoid arthritis (RA) in unclassified arthritis (UA). Methods. MEDLINE, Embase and BIOSIS were searched from 1987 to May 2019. Studies evaluating any imaging test in participants with UA were eligible. Reference standards were RA classification criteria or methotrexate initiation. Two authors independently extracted data and assessed validity using QUADAS-2. Sensitivities and specificities were calculated for each imaging characteristic and joint area. Summary estimates with 95% confidence intervals (CI) were estimated where possible. Results. Nineteen studies were included; 13 evaluated MRI (n=1,143; 454 with RA) and 6 evaluated ultrasound (n=531; 205 with RA). Studies were limited by unclear recruitment procedures, inclusion of patients with RA at baseline, differential verification, lack of blinding and consensus grading. Study heterogeneity largely precluded meta-analysis, however summary sensitivity and specificity for MRI synovitis in at least one joint were 93% (95% CI 88%, 96%) and 25% (95% CI 13%, 41%) (3 studies). Specificities may be higher for other MRI characteristics but data are limited. Ultrasound results were difficult to synthesise due to different diagnostic thresholds and reference standards. Conclusions. The evidence for MRI or ultrasound as single tests for predicting RA in people with UA is heterogeneous and of variable methodological quality. Larger studies using consensus grading and consistently defined RA diagnosis are needed to identify whether combinations of imaging characteristics, either alone or in combination with other clinical findings, can better predict RA in this population.

Photoacoustic technology for biological tissues characterization

The existing photoacoustics (PA) imaging systems showed mixed performance in imaging characteristic and signal-to-noise ratio (SNR). This work presents the use of an in-house assembled PA system using a modulating laser beam of wavelength 633 nm for two-dimensional (2D) characterization of biological tissues. The differentiation of the tissues in this work is based on differences in their light absorption, wherein the produced photoacoustic signal detected by a transducer was translated into phase value that corresponds to the peak amplitude of optical absorption of tissue namely fat, liver and muscle. This work found fat tissue to produce the strongest PA signal with mean ± standard deviation (SD) phase value = 2.09 ± 0.31 while muscle produced the least signal with phase value = 1.03 ± 0.17. This work discovered the presence of stripes pattern in the reconstructed images of fat and muscle resulted from their structural properties. In addition, a comparison is made in an attempt to better assess the performance of the developed system with the related ones. This work concluded that the developed system may use as an alternative, noninvasive and label-free visualization method for characterization of biological tissues in the future.

Dome-Shaped Pituitary Enlargement in Primary Hypothyroidism: Avoiding Neurosurgical Interventions

We describe three cases of primary hypothyroidism which presented initially to neurosurgery department with pituitary hyperplasia. We have found a novel pattern of ‘dome shaped’ enlargement of pituitary in MRI of these patients. Out of these 3 patients, in two of them, the planned surgery was deferred when endocrinologists were consulted and the pituitary hyperplasia completely resolved with levothyroxine treatment. In the third case, pituitary surgery was already performed before endocrinology consultation and histopathology revealed thyrotroph hyperplasia. The hyperplastic lesions described typically have a homogenous symmetrical ‘dome’ shaped architecture unlike the non-functioning pituitary adenoma (NFPA), which usually might often be of varying shapes and homogeneity. Analysis of pituitary images from similar case reports published in literature, also showed this typical ‘dome’ shaped pituitary enlargement. This imaging characteristic can be a clue to look for underlying hormone deficiency, especially in primary hypothyroidism. Therefore, a thorough endocrine evaluation especially looking for primary hypothyroidism in such dome shaped pituitary lesions are mandatory to prevent unwarranted neuro-surgical intervention as treatment of primary hypothyroidism may result in resolution of the abnormal enlargement.

Mengenal gambaran ultrasound lesi jinak, ganas dan metastasis pada nodus limfa leher menggunakan ultrasonografi

Objectives: This study is aimed to review the ultrasound imaging (USG) of benign, malignant and metastases lesions in cervical lymph nodes. Literature Review: This article was written based on some scientific literatures in which will explain the interpretation technique and imaging characteristic to distinguish between benign, malignancies and metastases lesions in cervical lymph nodes through ultrasound imaging. There are many pathological conditions may occur in cervical lymph nodes that can be analyzed in ultrasound. The signs of benign, malignant and metastases lesions in cervical lymph nodes, all may have different characteristics. Those characteristics could help the practitioners and radiologists to distinguish the lesions based on several assessment categories. Hopefully, the reader of this article could understand the technique to distinguish benign, malignant and metastases lesions in neck lymph nodes in ultrasound. Conclusion: Ultrasonography is the most commonly used modality for lymph nodes examination, although the accuracy cannot be trusted or guaranteed 100% but this modality always be used and becoming one of all choices. Through the ultrasound, it could be concluded that some of the characteristics of the assessment can be a guide to distinguish benign, malignant and metastases lesions in cervical lymph nodes.